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Childhood sexual abuse (CSA) and emotional maltreatment are salient risk factors for the development of major depressive disorder (MDD) in women. However, the type- and timing-specific effects of emotional maltreatment experienced during adolescence on future depressive symptomatology in women with CSA have not been explored. The goal of this study was to fill this gap.
Methods
In total, 203 women (ages 20–32) with current depressive symptoms and CSA (MDD/CSA), remitted depressive symptoms and CSA (rMDD/CSA), and current depressive symptoms without CSA (MDD/no CSA) were recruited from the community and completed self-report measures. Depressive symptoms were assessed using the Beck Depression Inventory (BDI-II) and a detailed maltreatment history was collected using the Maltreatment and Abuse Chronology of Exposure (MACE). Differences in maltreatment exposure characteristics, including multiplicity and severity of maltreatment, as well as the chronologies of emotional maltreatment subtypes were compared among groups. A random forest machine-learning algorithm was utilized to assess the impact of exposure to emotional maltreatment subtypes at specific ages on current depressive symptoms.
Results
MDD/CSA women reported greater prevalence and severity of emotional maltreatment relative to rMDD/CSA and MDD/no CSA women [F(2,196) = 9.33, p < 0.001], specifically from ages 12 to 18. The strongest predictor of current depressive symptoms was parental verbal abuse at age 18 for both MDD/CSA women (variable importance [VI] = 1.08, p = 0.006) and MDD/no CSA women (VI = 0.68, p = 0.004).
Conclusions
Targeting emotional maltreatment during late adolescence might prove beneficial for future intervention efforts for MDD following CSA.
Families have the potential for causing harm and can play a part in the onset of mental health problems. Women’s behaviour is judged by a different set of standards to that of men. Parents still socialise girls differently from boys. The pressures of family life chip away at our confidence and self-esteem and powerfully influencing our ability to make successful adult relationships. Girls and women may be told that they are ‘hysterical’ or ‘out of their mind’ when their emotional response is quite justified by what is happening to them. However, life pressures can also trigger mental illness, and family stress such as living in poverty and with domestic violence can make this worse. Girls and young women experience much more sexual abuse during childhood than boys – the sheer extent of which was not acknowledged in the past. Improving material and psychological support to families is a mammoth task, but what is within our power, among our own friends, families and communities, is to do something when we suspect that young women are experiencing trauma and abuse – believing, helping and supporting them to find someone to share their stories with who is trustworthy and skilled.
This study aimed to delineate profiles of self-regulation among sexually abused children and their association with behavior problems using a person-centered approach. A sample of 223 children aged six to 12, their parents, and teachers were recruited in specialized intervention centers. Latent profile analysis revealed four profiles: (1) Dysregulated, (2) Inhibited, (3) Flexibly Regulated, and (4) Parent Perceived Self-Regulation. Children from the Flexibly Regulated profile showed relatively low behavior problems, and those from the Dysregulated profile were characterized by high behavior problems. Children from the Parent Perceived Self-Regulation profile showed overall good adaptation, although teachers reported higher behavior problems than parents. Children from the Inhibited profile, characterized by the highest level of inhibition but low parent-rated emotion regulation competencies and executive functions, showed the highest level of internalizing behavior problems, indicating that high inhibition does not necessarily translate to better adaptation. Results also show a moderation effect of sex. Being assigned to the Inhibited profile was associated with decreased externalizing behaviors in boys and increased internalizing behaviors in girls. This study underscores the complexity of self-regulation in sexually abused children and supports the need to adopt a multi-method and multi-informant approach when assessing these children.
This chapter charts sexual violence over time and place, showing substantial shifts in thinking about sex as violence, rape as an assault on property, emerging ideas of consent, and changing attitudes towards the victim and the offender. It traces how sexual violence was defined and understood, in both society and law, from the classical world to today, examining case studies that include rape, sodomy and offences against children. It examines the structural impediments to the prevention of sexual violence, and the social and legal barriers to justice when a crime did occur. It highlights the fact that responses to sexual violence vary between individuals and communities, though survivors reveal that many forms of sex might be experienced as violent or traumatic, regardless of whether the acts were normalised or criminalised. Ideas of sexual violence are read through intersectional lenses, highlighting the idea that normative ideas of gender, sexual identity, race and class heightened the potential for sexual exploitation of marginalised groups. Limited, fragmented or unrepresentative sources make it challenging to trace sexual violence in history, but it is imperative to do so, as sexual crimes have had a substantial impact on the life experiences of individuals and their families and communities.
Prosecutors’ decisions in common law jurisdictions remain understudied. Drawing on examples in Australian cases of child sexual abuse, this chapter provides insights into case attrition or advancement at the discretion of the prosecution. We discuss contextual factors that support this expanding area of prosecutorial practice, including legislation, available special measures for vulnerable complainants, and recommendations of the Australian Royal Commission into Institutional Responses to Child Sexual Abuse. We review factors that influence decisions on charges, whether a case proceeds, plea negotiation, jury versus judge-alone trials, and joint trials. These factors include the age difference between complainants and offenders, the time lapse between alleged offending and reporting, the quality of prerecorded interviews, and the amount of evidence. Recent research and developments affecting decisions by prosecutors about evidence by the complainant and expert witnesses in CSA trials are summarized. We conclude with suggestions for future research to expand understanding of the role of prosecutors’ decisions in this discrete area of criminal justice process.
In this book, James Gallen provides an in-depth evaluation of the responses of Western States and churches to their historical abuses from a transitional justice perspective. Using a comparative lens, this book examines the application of transitional justice to address and redress the past in Ireland, Australia, Canada, the United States and United Kingdom. It evaluates the use of public inquiries and truth commissions, litigation, reparations, apologies, and reconciliation in each context to address these abuses. Significantly, this novel analysis considers how power and public emotions influence, and often impede, transitional justice's ability to address historical-structural injustices. In addressing historical abuses, power fails to be redistributed and national and religious myths are not reconsidered, leading Gallen to conclude that the existing transitional justice efforts of states and churches remain an unrepentant form of justice. This title is also available as Open Access on Cambridge Core.
Survivors of childhood trauma are at increased risk of complex post-traumatic stress disorder (CPTSD). The Recovering from Child Abuse Programme (RCAP) is a cognitive behavioural therapy (CBT) group promoting adaptive coping strategies which may help overcome CPTSD symptoms in adult survivors of childhood trauma. We sought to explore patient experiences of factors influencing treatment acceptability and potential mechanisms of therapeutic change in a sample of participants in the RCAP programme. As the group was delivered during the COVID-19 pandemic, necessitating a transition to remote therapy, we further aimed to capture experiences of the transition to telehealth delivery of the programme. A naturalistic sample of 10 women with CPTSD attending a specialist out-patient psychological trauma service participated in the study. Therapy sessions were recorded, transcribed verbatim and group members completed written feedback forms following each session. Reflexive thematic analysis was used to analyse the written feedback and transcripts. The RCAP was acceptable to group members and several themes were identified related to the experience of change in the group. Key themes centred on group solidarity; safety in the psychotherapeutic process; schema changes related to the self, others and future catalysed by the shifting of self-blame; increased emotional regulation to feel safer in the present; and increased future optimism. Therapeutic progress continued following the transition to telehealth, although face-to-face delivery was generally preferred. The programme was acceptable and led to cognitive change, enabling increased emotional regulation in the present and improved self-concept, thereby addressing key symptoms of CPTSD.
Key learning aims
(1) To identify potential mechanisms of therapeutic change related to participation in the Recovery from Childhood Abuse group CBT intervention.
(2) To understand factors influencing acceptability of the group intervention among women with CPTSD to childhood sexual abuse.
This article concerns child sexual abuse in the Anglican Church of Australia and the Church of England and, in particular, an integrity system to combat this problem and the ethical problems it gives rise to. The article relies on the findings of various commissions of inquiry to determine the nature and extent of child sexual abuse in the Anglican Church. The two salient ethical problems identified are: (1) design of safety measures in the light of the statistical preponderance of male on male sexuality; (2) justice issues arising from redress schemes established or proposed to provide redress to victims.
This article examines the contribution of the Royal Commission into Institutional Responses to Child Sexual Abuse to the ecclesiology of the Anglican Church of Australia (ACA). The focus is on diocesanism – the strong form of diocesan autonomy that exists in the ACA. The article concludes that the Royal Commission identified diocesanism and the associated dispersion of ecclesial authority as key factors constraining the ACA’s responses to child sexual abuse, and actively sought to modify its impact. The article also points to the significance of the Royal Commission’s findings to ACA ecclesiological understandings and change.
Researchers face an important challenge when assessing peer victimization in children, since self-reports are often discrepant with parent-reports. A latent class analysis identified patterns of response to items assessing peer victimization, which were either divergent or convergent between the parent and the child. Classes were then compared on the child sexual abuse status and on various behavioral and social outcomes. Participants were 720 school-aged child victims of sexual abuse and a comparison group of 173 nonvictims and their caregivers. We identified two discordant subgroups (self-identified and parent-identified) and two concordant groups (nonvictims and concordant victims of peer victimization). Compared to children of the comparison group, sexually abused children were five times more likely to be identified as targets of peer victimization solely by their parent than the contrary. Sexually abused children with concordant reports of peer victimization showed the poorest adjustment on all studied outcomes assessed 6 months later. Children who discounted experiencing peer victimization while their parent reported it were also at risk of maladjustment. Results underscore the importance of supplementing self-reports with other available sources of information, especially in young and vulnerable populations who may be inclined to discount their victimization experiences.
Child sexual abuse (CSA) is a serious scourge that affects all countries globally. While there are myriad factors contributing the prevalence of CSA in Zimbabwe, poverty is arguably one of the major underlying issues and root causes of most of these factors. Over the past two decades, Zimbabwe has gone through an unprecedented economic meltdown; fewer resources are being channelled towards child protection leading to the decline in standards of living for children. Consequently, children are left vulnerable to poverty which exposes them to the risk of CSA. This paper discusses a number of poverty-related factors that are contributing to CSA in Zimbabwe. A qualitative study approach was adopted, and data were collected from 38 participants and four key informants who were selected using theoretical and purposive sampling, respectively. In addition, 300 court files of CSA cases were also reviewed. Notwithstanding other circumstances leading to CSA, findings showed that poverty-related vulnerabilities, such as adverse living conditions, rurality, child labour and migration, exposed children to CSA. The paper ends by discussing the policy and social work practice implications and recommendations in view of the findings.
This study from Norway examines mental health status of women with child sexual abuse (CSA) who formerly had outpatient psychotherapy for anxiety disorders and/or depression. The relative contributions of CSA and other family background risk factors (FBRF) to aspects of mental health status are also explored.
Subjects
At a mean of 5.1 years after outpatient psychotherapy, 56 female outpatients with CSA and 56 without CSA were personally examined by an independent female psychiatrist. Systematic information about current mental health and functioning was collected by structured interview and questionnaires.
Results
Among women with CSA 95% had a mental disorder, 50% had PTSD, and mean global assessment of functioning (GAF) score was 61.8 ± 10.6. In contrast, 70% of women without CSA had a mental disorder, 14% had PTSD, and mean GAF 71.2 + 8.5. GAF and trauma scale scores were mainly determined by CSA, while FBRF mainly influenced the global psychopathology and dissociation scores.
Discussion
We have little knowledge on the mental health status at long-term in women with CSA who had psychotherapy. This study found their mental status to be rather poor, and worse than that of women without CSA who had psychotherapy for the same disorders. From the broad spectrum of mental disorders associated with CSA, this study concerns only women treated as outpatients for anxiety disorders and/or non-psychotic depressions.
Conclusion
Women with CSA showed poor mental health at long-term follow-up after treatment. The fitness of the psychodynamic individual psychotherapy given, or to what extent treatment can remedy the consequences of such childhood adversities, is discussed.
Though attitudes towards sexual violence shift and change over time and place, across the past two hundred years child sexual abuse has predominantly been viewed as a heinous crime. Nonetheless, there were many variations on what constituted sexual assault, and how this was understood in the community. An act that might be a heinous crime in one time period or one region may be legally and socially acceptable in another. This chapter will chart a range of attitudes and responses towards child sexual abuse. It argues that children have long been seen as vulnerable to sexual assault, which was understood as morally problematic and often a criminal offence. Yet despite significant social and legal change, state and community practices have failed to solve the problem of vulnerable children, and sexual assault of minors continues to be an issue across the globe.
To date, little is known about manifestations of child sexual abuse (CSA) within ultra-orthodox Jewish communities both in Australia and abroad. There is a paucity of empirical studies on the prevalence of CSA within Jewish communities, and little information on the responses of Jewish community organisations, or the experiences of Jewish CSA survivors and their families. This paper draws on a case study of two ultra-orthodox Jewish organisations from the recent Australian Royal Commission into Institutional Responses to Child Sexual Abuse to examine the religious and cultural factors that may inform Jewish communal responses to CSA. Attention is drawn to factors that render ultra-orthodox communities vulnerable to large-scale CSA, religious laws and beliefs that may influence the reporting of abuse to secular authorities, and the communal structures that may lead to victims rather than offenders being subjected to personal attacks and exclusion from the community. Commonalities are identified between ultra-orthodox Jews and other faith-based communities, and reforms suggested to improve child safety across religious groups.
This Element describes child sexual abuse and the formal organizations in which it can occur, reviews extant perspectives on child abuse, and explains how an organization theory approach can advance understanding of this phenomenon. It then elaborates the main paths through which organizational structures can influence child sexual abuse in organizations and analyze how these structures operate through these paths to impact the perpetration, detection, and response to abuse. The analysis is illustrated throughout with reports of child sexual abuse published in a variety of sources. The Element concludes with a brief discussion of the policy implications of this analysis.
According to the developmental psychopathology framework, adverse childhood experiences, including child sexual abuse (CSA), may alter the course of normal development in children. Attachment security has been identified as a protective factor against psychopathology and may thus play a critical role in predicting victims’ adaptation. The main objective of the present study was to investigate the mediating effect of attachment representations in the relation between CSA and behavior problems over a 1-year period. The sample consisted of 391 children (251 sexually abused) aged 3.5 to 6 years. The Attachment Story Completion Task and the Child Behavior Checklist were used. Disorganized attachment partially mediated the relation between CSA and children's internalizing and externalizing behavior problems 1 year following the initial assessment. This mediation effect was not found for ambivalent nor secure attachment dimensions. Child gender was found to moderate the association between CSA and disorganization, with larger effects of CSA among boys. These findings underscore the importance of considering attachment representations in treatment programs for preschool victims. Evidence-based practice focusing on trauma could be combined with an attachment-based intervention targeting the parent–child relationship. Moreover, interventions should be gender sensitive, as CSA appears to affect boys and girls differently.
In January 2013 the Australian Government established the Royal Commission into
Institutional Responses to Child Sexual Abuse. The terms of reference require
the Royal Commission to inquire as what should be done to eliminate or reduce
impediments that currently exist for responding appropriately to child sexual
abuse and related matters in institutional contexts, including addressing
failures in, and impediments to, reporting, investigating and responding to
allegations and incidents of abuse. Further, the Commission is directed to focus
on systemic issues and to be informed by an understanding of individual cases.
In November 2013 the Royal Commission held a public hearing into the Anglican
Diocese of Grafton's response to child sexual abuse at the North
Coast Children's Home and in October 2014 published its Report.
Despite the advances in child maltreatment research, there is still the need for comprehensive information about how abuse affects a broad range of categories of young adult functioning, and the extent to which these vary by sex. We examined the associations between child physical abuse (PA) and sexual abuse (SA) and six areas of functioning (mental health, physical health, life satisfaction, illegal substance use, alcohol problems and daily smoking).
Methods.
Data were obtained from the 1983 Ontario Child Health Study and follow-up in 2000/2001 (n = 1893). Multilevel regression estimated the adjusted associations for PA (with severity) and SA with each of the outcomes. Estimates with an entire sample were presented with sex-by-abuse interactions to examine sex differences and then presented separately by sex.
Results.
In the adjusted model, severe PA and SA were associated with impairment in mental health, and both forms of PA (severe and non-severe) and SA were associated with low life satisfaction. In addition, severe PA was associated with illegal substance use. Child abuse variables were not associated with poor physical health, alcohol problems or smoking. Although sex-stratified analyses revealed different patterns, there was no significant sex difference in the integrated sample.
Conclusions.
This is among the first community-based studies to show a strong association between child PA and SA and low life satisfaction in young adults. The abuse effects were similar for both sexes.
This study analyzes the prevalence and characteristics of childhood and adolescence sexual abuse suffered by a sample of university students, as well as the variables associated with the nature of abuse. Participants anonymously completed the Questionnaire on Child Sexual Abuse, in order to obtain information about experience of sexual abuse. Of a total of 2,375 students, 289 (12.2%) declared having suffered sexual abuse before the age of 18. The invasiveness, continuity, and severity of abuse was related to the location where the abuse took place (the more severe cases were committed in the homes of the victim and perpetrator) and to the circumstances of abuse (relationships with partners/at a party or while caring for a child predicted more severe abuse). The age of the victim (preschool) and an intrafamilial relationship between victim and perpetrator were also related to more invasive, continuous, and severe sexual abuse. The knowledge of characteristics of perpetrator and victim and the context in which sexual abuse occurs can help to better comprehend the nature and correlates of sexual abuse. The results of the present study may contribute to the design of programs for the prevention of sexual abuse to minors.
One of the major ways child sexual abuse can have an impact on individuals is in their later ability to have and maintain fulfilling couple relationships. Survivors may experience avoidance behaviours that become problematic in their adult intimate relationships. If couple therapists fail to focus on these traumatic imprints, the therapy may founder. This paper proposes that a multi-theoretical approach enables the couple therapist to deal with the complex problems such couples present including sexuality and intimacy concerns. Such an approach integrates trauma theory, attachment theory, feminist principles, body-oriented psychotherapy, and systemic couple therapy.